Intercostal artery reattachment for prevention of spinal cord ischaemia.

Herein, we illustrate different techniques for intercostal artery (ICA) reimplantation during thoracoabdominal aortic (TAA) surgery (1). Case 1 (loop graft): 23-year-old female with Marfan syndrome who presented with a type B aortic dissection during pregnancy, managed conservatively. On surveillance, the proximal descending diameters expanded significantly, and an extent II TAA repair from distal to left subclavian artery (LSA) to infrarenal aorta was planned. The proximal clamp was placed proximal to the LSA, which was snugged, in order to resect the dissection flap that originated within the arch. Case 2 (island patch): 37-year-old male with Marfan syndrome who presented with a type B aortic dissection two years prior, initially managed conservatively until the proximal thoracic diameters began expanding. He was planned for an extent II TAA replacement from the distal to LSA to individual iliacs. Case 3 (end graft): 65-year-old male with degenerative extent IV TAA aneurysm. Planned extent IV TAA replacement from lower to iliac bifurcation. Motor-evoked potential (MEP) signal decreased intraoperatively during opening of the visceral segment and a single large lumbar artery was reimplanted to the main graft using an end graft technique.